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HomeMy WebLinkAboutBld-20-001881 d / 9 r.57- 060039 W /oI /c] hf ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department op 1146 Route 28,South Yarmouth,MA 02664-4492 �' � 508-398-2231 ext. 1261 Fax 508-398-0836 A ,, '�� Massachusetts State Building Code,780 CMR I' Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling ~ s..)j This Section For Official Use Onl Building Permit Number: DT ZQ" mig-r/.Date Applie - )1rN StACS J lu��-1� Building Official(Print Name) Signature Date • SECTION 1:Slit INFORMATION. V 1.1 Pro r ddress• 1.2 Assessors Map&Parcel Numbers 5►� �xbeVe\,. Lr. Lo I p 1.1 a Is this an accepted street?yet' ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water_er Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public LT Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system t Check if yeslir SECTION 2 PROPERTY OWNERSHIP' - 2.1 O of Record \ c V -L A4 Name(Print) City,State,Z `] \--ViGv..o}4 L .. 714 575 2.11 Y1112 riticAY A @ 4q ,Gt No.and Street Telephone Finail Address ' SECTION.3:.DESCRIPTION OF PROP W OSED ORIO(check alb that apply) New Construction 0 Existing Building' Owner-Occupied 0 Repairs(s))C Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:Brief Des 'dim Qf Proposed Worl2: vi •e j 's . (. %mac A. bock ers . V Pp 4c.Q �'2. ► cv44c4 e \r-n a\✓% P awl._ ��� - eat- 'reQ\cam - a p4. ,i . SECTION.4:ESTIMATED CONSTRUCTION COSTS. ,. , : • Item Estimated Costs: Of e.ial Tse Oily, ' (Labor and Materials) _ _ , 1.Building $ 1 i O sV a :1..Building Permit Fee;$ 150.. Indicate how fee is determined: nrla 2.Electrical $ aStard City/TownApplicationl ee:':, ❑.Total'Projeut Costa(Itein,6).x multip'er.... - x 3.Plumbing — $ 2: Other Fees: $ S d q 3/ 4.Mechanical (HVAC) $ L>st 5.Mechanical (Fire $ Suppression) Total All Fees:$ 6.Total Project Cost $ CheckNb..V Check Amount V Cash Amours ' �1 o i D ii Paid in'F•un • 0 Outstanding BalaTice Due:tiff --#9369 4IjStiV '; SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C — O1 o s-13/ I ZO Zt O V' License Number Expiration Date Name of CSL Holder Say &-s% \_ C 14. List CSL Type(see below) No.and Street` C� 1X T e Description 0 D 333 ( ) Unrestricted(Buildings up to 35,000 cu.R) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry 5 2(0 cq(c)(1 RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances �I &la einnt.13 Cwca ,,((��,ne` I Insulation Telephone mail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 f'.�--) CAD-),A.o �OZ ` " - (loC‘°'a S�S Registration Number Expiration Date HIC Sarnany Name priIC Registrant Na�e� ] _ No.and Str `lam c� , 1.�1 Q 2vl K 1 S`r ee�nC ►'1 t4. , .S •• qwt .ir 32 C a L/ adareas City/Town,State,ZIP & a 333 Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit Signed Affidavit Attached? Yes 1;37. No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLE LED WHEN • OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .. I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. )o� � .; 9 3[\C Print Owner's Name(Electronic Signature) Date • SECTION 7b:OWNER'.OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. V:s\StevA" aums � C'� Z31/S Print Owner's or Authorized Agent's Name(Electronic Signature) Date • NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) • Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" .. .-61"11YLtisTOWN OF YARMOUTH BUILDING DEPARTMENT : • 1146 Route 28,South Yarmouth,MA 02664 �.•0 p 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR, Chapter 1,Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at .-Li // Yl 1 v Work O X�,jE�vk. l� �-ES T T W�'�J� � Y� Address crAle- Ls to be disposed of at the following location: 0(..)wA o1,- , Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. sC) ) /2- Signature of A li 3//pp cation Date Permit No, The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dla Workers'compensation Insurance Affidavit:eutfders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name(Business/Organizational/Individual): ROBERT W DENNIS JR d/b/a/HOME STRUCTURAL SPECIALISTS Address: P 0 BOX 534 City: EAST BRIDGEWATER State: MA Zip: 02333 Phone ll: 506-326-2464 Are you an employer?Check the appropriate box: Type of project(required): 1• 11. I am an employer with 2-3 employees(full and/or part time)* I t 7. New construction C2. I am a sole proprietor or partnership and have no employees working for me in any 8. Remodeling capacity.[No workers'comp.insurance required.] 1119. Demolition r—3. I am a homeowner doing all work myself.[No workers'comp.insurance required]* ❑10. Building addition _ 4. I am a homeowner and will be hiring contractors to conduct all work on my property. 011. Electrical repairs or additions I Will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 012. Plumbing repairs or additions Es. I am a general contractor and I have hired the sub-contractors listed on the attached 013. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.± El6. We are a corporation and its officers have exercised their right of exemption per MGL. Z14. Other c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit Indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ±Contractors that check this box must attach an additlonarsheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am on employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INS. CO Policy II or self ins.Lic.fl: WC2-3I S-621333-019 Expiration MAY 31, 2020 Job Site Address: S� c L-A t C(3,c1LLY .d(L y ` . -t,ate:A 0.,04.0 , vvvA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL.c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct,and that clicking this checkbox a ping my name in the fie low will a s my signature. \ ` , _ 315 Name: Date: � Phones:. 508-326-2464 Email: RWDENNISJR a@COMCAST.NET ® DATE(MM/DDIYYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 09/30/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT Justin DeLoach MCSWEENEY AND RICCI INS AGENCY INC IpA//C"No.Est): (781)848-8600 FAX (A/C,No): ADDRESS: jdeloach@mcsweeneyricci.com PO BOX 850984 INSURER(S)AFFORDING COVERAGE NAIC# BRAINTREE MA 02185 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: ROBERT W DENNIS JR&DONALD A ATKINSON INSURER C: DBA HOME STRUCTURAL SPECIALISTS INSURERD: PO BOX 534 INSURER E: EAST BRIDGEWATER MA 02333 ,INSURER F: COVERAGES CERTIFICATE NUMBER: 454739 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP w LIMITS LTR INSD VD POLICY NUMBER IMM/DD/YYYYI (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(My one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILELIABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _(Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PEATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A WC231S621333019 05/31/2019 05/31/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addfional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside.of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensation/investigations/. No partners have elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN John Patrick ACCORDANCE WITH THE POLICY PROVISIONS. 54 Boxberry Ln AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 Daniel M.Cro v ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DivisCommioonwealth nof Professional of Massachusetts Licensure Board of Building Regulations and Standards Constritet iltiSupervisor CS-018348 Expires:08/31/2021 ROBERT W DENNIS a - 524 BRIDGE ST POB* EAST BRIDGEEVATEB 2333 Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration, Expiration 11827? 02/20/2021 ROBERT W.DENNISJ#. Di IA HOME STRUCTIARAL SPECIALISTS • ROBERT W.DENNIS JR .CCL1--- 524 BRIDGE ST. EAST BRIDGEWATER,MA 02333 Undersecretary DIVISION OF PROFESSIONAL iw . ENSURE •p ISOWES 4 L.PENOM .'. PO DOE :.. 411, .'. ilii.iRESTIk 136E4 .4 . Ft 4 P•d ii Ah� Robert W. Dennis Jr. Registered Structural Engineer Don Atkinson dba/ Home Structural Specialists P.O. Box 534 East Bridgewater, MA 02333 508-326-2464 rwdennisir(c comcast.net www.homestructuralspecialists.com Revised Proposal Structural Work 54 Boxberry Ln. W Yarmouth, Ma September 21, 2019 We propose to provide engineering design, obtain building permit, and provide labor and material to perform structural work at a property located at 54 Boxberry Ln. W Yarmouth, Ma. Work generally will consist of the following: 1. In crawl space, provide cribbing, lumber, and hydraulic jacks to temporarily support floor joists 2. Install 3 new 2 ft. x 2 ft. x 1 ft. reinforced concrete footings 3. Replace approximately 32 ft. main beam with new (4 ply) 2 x8 pressure treated 4. Replace or sister approximately 20 floor joists 5. Install 3 new double block piers 6. Remove temporary supports 7. Cleanup Estimated time 4-5 days Cost$10800 Deposit when sign contract$800 Deposit when work begins $4500 Payment when work complete $5000 Payment after final inspection $500 All work will be done in a professional manner to the complete satisfaction of the owner. We will remove debris and install a 6 mil vapor barrier to the bottom of the joists When work is complete, owner agrees to contact the local building inspector for a final inspection at(508-398-2231). This is necessary because the inspector requires that someone be home when they come for the inspection. Please call if you have any questions. Bob Dennis 508-326-2464 Don Atkinson 781-724-4257 Please sign the contract, and return it with the deposit payable to Home Structural Specialists, P.O. Box 534, East Bridgewater, MA 02333. Upon receipt, we will proceed with obtaining a permit and schedule the work. CONTRACT Contractor Home Structural Specialists Owner 1IL� « ,JG;/iru -l. a-7Z� cG ' ure � Print ,� Owner / / L_ .a j i v 404 7 F � ic Signature Print Date 9 Ja /9- Best number to reach you / 4/ 7 it =� 73 2_ i 7 - John A.Patrick Ph#(508)529-3434 10t77 5636 s Patricia M Patrick Vow a 1, 53-7132/2113 7 Hickory Ln Upton,MA 01568 DATE CC PAY TO TH / G.Eth j+./ c C��7 `,' `� I i n e'ORDER OF � 1 r it ' ( _rY i, N L 1� Dot 8 , !/1 MILF011G F6DiM4 BAKIN09 mu.r©RD ANC OOAN MINCRIA 1� N P OBRAL MILFORD.MABBAGHUBETTH D1707 1 IMMWMR 1: 2ii37L32Gs: 02 0532- LP° 5536 y ..++ -- -.. ..q. .. .-: {L._ x+1Bw!sa... �..:. -, ;.. ..,®... .- ♦ - ..pax..- .. •• Google Maps 56 Checkerberry Ln ., . . . , . pl.'. .erf• to %, ,. ',...., ' c ." .4''ll• • , J. ..8, "1:;, ,... ' ... • ... .... ', — '''Wiliot:- ''': .' ,.+NO' .• - . . It ..., . - . r 1 i Iii i 1 .1 - ---4. Google Image capture:Jul 2014 ©2019 Google Yarmouth,Massachusetts 2 Google Street View-Jul 2014 .... leo m 4 -/ kt.....0.........7... , ....... E — le •••i,i d )d Inflatable Park Whyd - )��xc&,eta•ci 1_ro1/4.l(—L. 0 \. I I rik -7 ae,Q latce, or S1sAet- III ao 4 tc - 6c s+S I ______ _.____ 3 M 5 �� 'ne� 2'x21xt AwS S t ‘01 ocjlz d III , ers C -Tt0.) N U .‘-- Qe p lace Irn G t h +60.,,41 Y wikki ilei.it..) (- - TOWN OF YA o.a:P - CA2.,,A,JL (7(2tC,�i. REVIEWED FOF'it'CINC ANC 2:"."I; J.ItT,DECOMPLI ANDE. ERPOt.C. oI; 1SSIf)\'S r)O NOT RELIEVE THE 21.7 APLICANT FROM THE REGPONIBILI i'(OF'AS BUILT" COMPLIANCE. DATE: — Fl�JILDING OFFICIAL ' :1._LC C : it ��tH OF Mq 13 Robert W. Dennis Jr f �. v o1 ROGER cti o�c�3�e e i ��( �,, Registered Structural Engineer x JR. m W , �ArQ;yvlp �, s? UCTURAL P.O. Box 534 9 0. 13834� East Bridgewater, MA ssoNAL Elk6 508-326-2464